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It’s decision time for BPCI Advanced

When
BPCI Advanced went live on October 1, more than 1,500 providers across the US
committed to the new bundled payment program model. As
reported last month, about 16% of those participants decided to withdraw
from BPCI Advanced. For many reading this, this spring provides an exciting opportunity
to expand participation in the program and commit more fully to value-based
care.

Recently, CMS announced that the Model Year 3 application period for BPCI Advanced would open in April and they do not intend to offer an additional enrollment opportunity. With the enrollment window expected to open any day now, providers still on the fence about applying should take action now to prepare for the application (You’ll have time to review your historical data later this spring or early summer.).

naviHealth’s
Vice President of Clinical Strategy Gina M. Bruno and Market President of the Central
Midwest region Tom Divinnie have provided the following key considerations for
your organization to assess its value-based strategy in a program like BPCI
Advanced.

Where to direct internal focus prior
to submitting your application

Implementation
is a big lift for BPCI Advanced. Many systems who are participating in BPCI
Advanced will need to bring together different stakeholder groups that may not
have historically held a forum to work together. You’ll also need to provide an
opportunity for communication and alignment among clinicians, case managers and
post-acute providers who are involved in discharge to discuss the goals of the
program.

You’ll
also need to think about your organization’s patient identification strategy. In
order to focus on identifying patients who will be contributed to BPCI
Advanced, you will need to utilize your data and infrastructure to segment your
population in an efficient manner. In other words, there is
a lot to accomplish internally in a short amount of time.

Market President Tom DivinnienaviHealth

VP of Clinical Strategy Gina M. BrunonaviHealth

Bruno and Divinnie co-presented a webinar on how to leverage BPCI Advanced as complementary framework to drive success as a part of your organization’s value-based care strategy. As experts on the BPCI Advanced program, both Bruno and Divinnie believe you should take a look at the following focus areas:

Look around:
Get to know the Physician Group Practices (PGPs) that are currently
participating in your area. (CMS has posted a full list of participants/episode
initiators on their website.)

Because
PGPs take precedence over Acute Care Hospital (ACH) participants, it’s
important to understand how their participation impacts volume and
opportunities for the ACH. You’ll also want to understand what other models,
including ACOs in your community, are active, as the interplay between them can
change how you prioritize, participate, and partner.

Look within:
What are your technology assets? What’s your data infrastructure? How will you
identify BPCI Advanced beneficiaries? How ready are you to redesign care? By
getting a handle on what resources you have in place internally, you’ll be
better prepared to manage change to move forward as an applicant. At this
stage, you can start aligning stakeholders across the system, engaging
physician leaders and starting to optimize care management workflows.

Look ahead:
Review the current request for application (RFA) on the CMS website as you think
carefully about participation. We expect the new application guidance to build
upon this, so it’s a great place to start. Explore Conveners and other partnerships
that can help you accelerate the implementation of a value-based care strategy
to drive real results quickly.

Look beyond: The
application window is just the start. We’ve seen in the past several years some
localized strategies based on reservations on new CMS models. BPCI Advanced can
be that center of excellence to help accelerate your value-based care strategy.
It can help lay the foundation for new and evolving models that CMS may
announce in the future. CMS is eager to provide more opportunities to downsize
risk and BPCI Advanced can be a great way to look well beyond this model and
position you for success.

But
it’s about a systematic approach – not only around what is possible within a
health system both in terms of efficiencies and resource applications, but also
in care redesign and outcomes with a spillover effect into your patient
population. BPCI Advanced is one way to get us over that hump so that a
systematic approach leads to quality outcomes for all.

Planning for BPCI Success: Next Steps

By getting a better handle on risk and clarifying your vision now, this period of “clinical discovery” for your organization is time well-spent.

Here
are four planning steps to take as the application period opens. For some
organizations, you may be well on your way through this list. If you’re just beginning
in your path toward value-based care, here are some important steps to take to
be better equipped for what’s next:

1.
Define your organization’s strategy for value-based care and how it applies to BPCI
Advanced.

2.
Identify your “change champions” and set a foundation for creating and maintaining
change.

3.
Draft your application(s)—or work with a Convener as part of their application.

4.
Assess clinical care patterns and identify best practices or opportunities for
improvement.

By
the time you read this, the application period for Model Year 3 may have already
opened, so start the conversation with key stakeholders in your organization
today, if you haven’t already. Remember, the application is non-binding, so
even if your organization decides against moving forward later, you’ve taken an
important step in terms of being ready for future value-based care initiatives.